Bedrest Coach Darline Turner-Lee, straight in from a walk in the rising Texas heat, educates mamas on bed rest about the importance of proper hydration during pregnancy, and the particular importance of proper hydration to mamas on bed rest. This vlog reviews why water is essential to a mama’s overall health; how it helps in the development of her baby, the risks of taking in too little water and how much water a mama needs daily and how to meet those needs.
I’m tossing yet another tidbit of information for Mamas on Bedrest to share and discuss with their doctors.
In a study published online on December 14, 2011 in the American Journal of Obstetrics and Gynecology, a coalition of researchers from around the world (United States, Austria, Brazil, Denmark, India, South Africa, Turkey, and the United Kingdom) concluded that vaginal progesterone, administered in the mid-trimester of pregnancy to women with shortened cervix detected via ultrasound, can cut their risks of preterm labor by as much as half.
I found this information very interesting given the current brouhaha over Makena (the progesterone injections used for prevention of preterm labor) and how progesterone is often used early in pregnancy for women with repeated miscarriages (my situation!).
The researchers reviewed data from 5 highly respected studies and evaluated the efficacy and safety of using vaginal progesterone for the prevention of preterm labor in the presence of cervical shortening with rates of neonatal morbidity and mortality. Here are their findings:
- Vaginal progesterone reduced the rate of birth at less than 33 weeks’ gestation by 42% . It also reduced the risk for birth at less than 35 weeks’ gestation by 31% and less than 28 weeks’ gestation by 50% *.
- Vaginal progesterone also improved the following outcomes: respiratory distress syndrome, a composite measure of neonatal morbidity and mortality, birth weight less than 1500 g, admission to neonatal intensive care unit and need for mechanical ventilation.
Given these outcomes, one would think that physicians and researchers across the board would be recommending that women receive progesterone if they presented with shortened cevix. But such was not the case. Two commentators felt that the data was not conclusive enough. Sarah Bradley, MD, clinical assistant professor of obstetrics and gynecology from the University of Wisconsin–Madison felt that the data was “murky”. Her position stemmed from the fact that different studies used different definitions for shortened cervix. She also noted that many women had received a cervical cerclage (surgical stitch placed to keep the cervix closed) in addition to the progesterone and felt that it couldn’t be definitively stated that the progesterone was in fact the true reason that preterm labor was averted.
Aaron B. Caughey, MD, PhD, director of women’s health and chair of obstetrics and gynecology, Oregon Health Sciences University, Portland, had a similar comment on the definition of shortened cervix. He also felt that the meta-analysis really didn’t add any new information to what is already “standard of care”.
As a result, researchers recommend that women be advised of both treatments. While it is commonly recognized that either a cerclage or progesterone alone is often enough to prevent preterm birth, many women may elect to have both treatments and that is okay. Researchers also recommend that further research be undertaken to specify “shortened cervix” and to give specific measurements at which treatments are beneficial. They also recommend research to assess the effects of race, ethnicity, socioeconomic status, and maternal age on cervical shortening and preterm labor.
While I’m all in favor of evidenced based research, sometimes I think we analyze things to death. We know that adequate progesterone levels are essential to maintaining a healthy pregnancy. We see progesterone used in early pregnancy, especially in cases where women have undergone fertility treatments and/or have luteal phase defects resulting in repeated miscarriage. We know that progesterone injections (Makena and compounded variations) are effective in prolonging pregnancy in the instances of preterm birth later in pregnancy but before 37 weeks gestation. So I am not surprised that using vaginal progesterone is effective in helping prolong pregnancy and prevent preterm birth in cases of shortened cervix.
But I am surprised that commentators are pulling up short in making the recommendation that vaginal progesterone be used in the mid-trimester. Is it really necessary to determine that progesterone alone will prevent preterm birth in the presence of a cerclage? Is it really so awful if a woman has a cerclage and uses vaginal progesterone if she has a shortened cervix? And while it will be nice to know how efficacious progesterone is in various races, ethnicities, socioeconomic levels and in women of advanced maternal age, must we wait to have all this data before making recommendations? Can’t we do the work concurrently? It has been shown that use of progesterone produces more good than harm, so why not use it as currently stated and make the specific recommendations as the study data becomes available?
Many will judge my opinion and I am fine with that. But I was a woman who had repeat miscarriages until we figured out that my progesterone levels were not adequate to support pregnancy to term (beyond 1st trimester actually!). I know women who benefited from having progesterone injections in the second and third trimesters to prolong their pregnancies. I think that I can safely say, It didn’t matter if we were white or black, rich or poor, “old” or young, if it helped us to maintain our pregnancies and have healthy babies, we were all for it! If it helps specific subgroups, even better.
But on behalf of high risk pregnant women everywhere, please don’t wait to use a treatment that has been shown to be safe and efficacious in preventing preterm birth just so that you can get “exact” data. If you know that progesterone is efficacious in preventing preterm birth in a woman who has a cervix of 20mm and has a cerclage, why not try it in a woman whose cervix is 15mm or even 10mm? If she is at such risk, why not try? As a physician and scientist, you may think that it’s a waste. But for the mama desperately hoping and praying for her baby, it’s hanging on to all hope by a thread. Please don’t cut us off.
*This post is a summary and commentary of the MedScape report and the published article in The American Journal of Obstetrics and Gynecology online journal. Statistical information was attenuated for ease of reading. To read the full study results, please read the complete texts provided here.
Have you taken progesterone during pregnancy? What was your experience? Please share you thoughts below. Sign up for our RSS feed on the upper right hand corner of our webpage and receive blog posts immediately when they are uploaded. Follow us on Twitter (@mamasonbedrest) and on Facebook.
Click to take the postpartum depression survey conducted by Case Western Reserve University http://filer.case.edu/~axp335/postpartdep.htm Thank you very much for your consideration.
A man was advised to leave his home as a storm was coming and everyone was to evacuate. He refused, but as the storm swelled, he found himself trapped. In an effort to “go above the rising waters”, he climbed up on his roof and begged God to help him. Not long after, a boat came by. The driver told the man to climb in and he’d take him to safety. The man refused saying, “God is going to save me.” The man in the boat continued on. After another couple of hours with the water reaching the eaves of his roof, the man again pleaded, “God, Please Save Me!” Then Emergency rescue personnel arrived and offered to help the man down and take him to safety. Again, he refused stating, “God is going to save me.” Shortly thereafter, the man perished. When he arrived in heaven, he asked God, “God, I begged and pleaded for you to save me. Why didn’t you?” God replied, “I sent you a man in a boat and a rescue squad, what more did you want?”
As humans, we often question and wonder why things happen the way that they do. When I was struggling to have my children, I often cried out to God, “Why can’t I have my children normally like every one else?” Normal is a very relative term.
There is a movement within the birth world to “return birth to its natural state”. I’m all for that. But not all women are going to be able to have the picture perfect pregnancy and birth. Some of us will require medication to become pregnant. Some of us, like me, will require medication (progesterone in my case) to remain pregnant. Others will require assistance to deliver their children. For example, my sister was a preemie born at 6 1/2 months. When she was having her children, she never went into labor. Her obstetrician “learned” (and I have no idea how they figured this out) that she did not receive the “signals” from her babies that would initiate labor. They summized that due to the fact that she was born early certain systems didn’t develop. (She was also born without a common Bile duct, so when she had her gall bladder out, they had to “reconstruct” one for her!) No matter what the reason, she has two healthy grown men now, thanks to “God’s provision” in the form of obstetrical care.
Sometimes life just doesn’t go as planned. I am so thankful that there are skilled physicians because without them, I would not have my children. While I wonder about the effects of bed rest on a mama’s body, I also know that in certain cases, it is the one thing standing between life and death for both mother and baby. We do far too many cesarean sections in this (United States) country, yet, had I even tried to deliver my daughter, she likely would not have survived, I likely would have hemorrhaged to death and my son wouldn’t exist either. Three people now live and are able to bless this world because there are skilled physicians who intervened on our behalf. They were blessed with skills. We are blessed with life.
Recently I posted a message about classes that I am offering for mamas on bed rest. I got this response from a CPM (Certified Professional Midwife):
I don’t believe in bedrest, so none of my clients would be on it. I believe it only prolongs the inevitable. Barring an incompetent cx, if the baby is healthy, it will stay in until its ready, if its not, might as well let nature take its course and get it over with.
Wow. That’s all that I can say. According to this woman, nature will always work and when it doesn’t, we should just let it go. I am here to say that I wholeheartedly disagree!! For me, the difference between having two healthy children and losing two pregnancies was progesterone. The difference between hemorrhaging to death and surviving were the skillful hands of my obstetrician who was able to manage my bleeding so that I live today! The difference between many women having children and not is the skills and care that many obstetricians and reproductive endocrinologists provide for them. So now it is wrong, somehow “unnatural” for those of us who need that assistance to forgo it, demanding instead “God’s provision in the form of a “natural” pregnancy and birth?
Every one is entitled to their opinion and this CPM is certainly entitled to hers. But I want to reach out to Mamas on Bedrest and to mamas who may not be on bed rest, but needed “a little help” to conceive or to deliver. There is no shame in assisted reproduction or in assisted childbirth! I am sure that like me, many of you prayed long and hard for your children. Are we now to refute them or the methods used to get them here? Of course not!
This woman’s words struck a cord in me because I have had many people comment that I am helping or encouraging women to go against nature. I totally disagree! I believe that if there is a path to your heart’s desire that is legal and effective, Take it! If I can help a woman to have a healthy child by supporting her through the tough patches, then I am going to do it. I see this as no different than helping families with children with special needs or helping a person with an illness manage it so that they can live a quality life. I know that I am speaking to the choir here, but for those of you feeling “less than” because you did not conceive naturally or deliver vaginally, look at it this way,
At least you didn’t miss the boat!!
Please share this with mamas who may be feeling “less than” because they had “help” having their children. If you liked this post, subscribe to this blog via the RSS feed button in the upper right hand corner of this page. Interact with us on Twitter (@mamas on Bedrest) and on Facebook.